Can We Claim Health Insurance From Two Companies?

Due to the abrupt rise in healthcare fees, medical costs, and the lifestyle changes that make a spike in ailments each passing day, there is a significant boost in people opting for higher insured amounts. Hence more people are buying multiple online health insurance policies across different insurance policy companies. With the multiple health and medical insurance policies, personal bought online health insurance, and the second one from the employer, the most common question arises: Can we claim health insurance from two companies? The answer is yes. One can claim health insurance or medical insurance from two or more companies. Except there are some conditions and processes, the policyholder needs to understand while claiming. The policyholder needs to inform details of other ongoing health insurance policy to the insurance company while filing the proposal form . Also its best to inform both the companies about any expected hospitalization claim to avoid late intimation query The article below will explain everything about claiming health and how we can claim medical insurance from two companies. Make sure to read till the end before initiating any claims.

How can we claim health insurance from two companies?

Claiming health insurance from two companies provides policyholders with flexibility during medical emergencies, but it can sometimes be a complex process. Here's a guide on how to handle this situation:

Evaluate Coverage:

Before making a claim, understand the coverage provided by each health insurance policy to determine the best approach.

Less Than Sum Assured:

If the claim amount is less than the sum assured of a single policy, the policyholder can only claim under one policy.

Cashless Claims:

If the policyholder is eligible for cashless hospitalisation at a network hospital, they should first raise the claim with their primary health insurance company and obtain the claims settlement summary. After receiving the settlement summary, the policyholder needs to submit the hospitalisation bills to the second health insurance company to request reimbursement for the balance amount.

Reimbursement Claims:

If the hospital where the policyholder receives treatment is not part of the network hospitals of either insurance provider, they must pay the hospital bills upfront. After paying the bills, the policyholder can claim reimbursement from both insurance companies by submitting the necessary documents with one insurer and once settled he/she can next submit the settlement letter and additional documents to the next insurer for further claiming .

Documentation:

Ensure all required documents, including bills, medical records, and claim forms, initial settlement details are are accurately filled out and submitted to the secondary insurance company .

Communication:

Maintain open communication with both insurance companies throughout the claims process to address any queries or concerns promptly.

How to claim health insurance from multiple insurers – An example

Claiming 2 health insurance plans at the same time requires a detailed study and a proper step-by-step process, which should be considered to make sure that you have a seamless process without any rejection. For example, let's consider Mr. Sharma, who has two health insurance policies: one with a coverage of Rs. 2 lakhs and another of Rs. 1 lakh. Now, when he required hospitalisation for hernia treatment costing Rs. 2.5 lakhs, he started his claim from both companies. Initially, Mr. Sharma approached his first insurer for cashless hospitalisation, utilising their network hospital. After treatment, the first insurer settled the claim up to Rs. 2 lakhs, with an outstanding amount of Rs. 50,000. However, the total cost is beyond the first claim accepted amount, Mr. Sharma has an option of putting a claim on the second insurance company. He would have to submit the initial insurance settlement details along with copy of claim documents and additional bills if any to the next insurance company. Who would then review the initial settlement details and process Mr. Sharma’s claim for the balance amount of Rs. 50000 basis the terms of the second policy.

Hedge against Rejection of Claims

Hedging against claim rejections in health insurance is like a strategic plan, with which you can reduce the financial risk, which is usually associated with denied claims. Multiple health insurance policies serve as a robust hedge, providing a safeguard against the adverse impact of claim rejection by one insurer. In essence, this strategy diversifies risk exposure, making sure that the insured individual or family is not left in an emergency, and ends up paying money from their own pockets. When a claim is denied by one insurer due to exhaustion of sum insured, policyholders can turn to another policy and ask for coverage for the medical expense. With this process, one can reduce the risk of potential financial burden, which often comes with the rejection of claims during emergencies. Moreover, it also highlights the importance of thorough policy evaluation and selection, as different companies have different criteria for their policy, and one should abide by it. Furthermore, by spreading coverage across multiple insurers, policyholders leverage the principle of risk pooling to their advantage. In the event of claim rejection by one insurer, the financial impact is reduced by the benefits provided by alternative policies. This proactive risk management approach underscores the importance of comprehensive coverage and diligent policy management in health insurance. However, it's imperative to exercise prudence and due diligence in navigating the complexities of multiple health insurance policies. Policyholders should carefully review policy terms, coverage limits, and exclusions to ensure alignment with their healthcare needs and financial objectives. Additionally, consulting with a knowledgeable insurance advisor can provide invaluable insights and assistance in optimising coverage strategies while minimising exposure to claim rejection risks.

Below are some frequently asked questions asked by a policyholder about health insurance claims:

1. After how many days the policyholder can claim the health insurance?

There are various aspects to decide the admissibility of a claim . In a standard indemnity health insurance there is an initial waiting period of 30 days from inception before insured can claim under the policy. The waiting periods applicable will also be decided basis the nature of the claim as the products usually have a waiting periods applicable for certain conditions.

2. In a year, how many times can a policyholder claim his health insurance?

Multiple times until the sum insured amount is exhausted. However, certain products may have a condition on the numbers of claims admissible in a year e.g. cover for Daily hospital cash or a vector born illness cover . One needs to check with the insurer before purchasing the health insurance policies.

Final Thoughts

At the time of unforeseen medical emergencies, to avail the best healthcare facilities in time, it is essential to invest in a health insurance policy plan that will grant you coverage for the medical treatment expenses. The policyholder has the liberty to invest in multiple health insurance policy plans and choose which policy needs to be used at the time required. The policyholder has a right to claim from two companies but need to make sure that the actual costs incurred for the treatment cannot be more than the sum claimed from the two health insurance policy companies.   *Standard T&C apply. **Tax benefits are subject to change in prevalent tax laws. Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms, and conditions, please read the sales brochure/policy wording carefully before concluding a sale.